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NPI Code Detail

MEDICARE: BAYSHORE PODIATRY CENTER INC

MEDICARE: BAYSHORE PODIATRY CENTER INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0131XFoot Surgery PodiatristFL
2213E00000XPodiatristP02913FL
3213ES0000XSports Medicine Podiatrist
4213ES0103XFoot & Ankle Surgery Podiatrist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093798704
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAYSHORE PODIATRY CENTER INC
Provider Business Mailing Address
First Line : 508 S HABANA AVE
Second Line : SUITE 230
City : TAMPA
State : FL
Zip : 33609-4181
Country : US
Telephone Number : 813-877-6636
Fax Number : 813-877-6610
Provider Business Practice Location Address
First Line : 508 S HABANA AVE
Second Line : 230
City : TAMPA
State : FL
Zip : 33609-4181
Country : US
Telephone Number : 813-877-6636
Fax Number : 813-877-6636
Authorized Official
Title or Position : PRESIDENT
Name : JAMES EDWARD REPKO
Credential : DPM
Telephone Number : 813-877-6636
Provider Enumeration Date : 11/28/2005
Last Update Date : 10/23/2024

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Practice Location Address:
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TAMPA, FL
33609-4181
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1811989874 — DR. RICHARD LARK DICICCO M.D.
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508 S HABANA AVE , SUITE 160
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1770576076 — MORRIS R HANAN M.D.
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508 S HABANA AVE , SUITE 260
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33609-4181
Practice Phone: 813-876-9191
Practice Fax: 813-876-3103
1548259047 — TAMPA ARTHRITIS CENTER PA
Practice Location Address:
508 S HABANA AVE , STE 120
TAMPA, FL
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1134198583 — DR. JOHN P LIPPELMAN M.D.
Practice Location Address:
508 S HABANA AVE , SUITE 220
TAMPA, FL
33609-4181
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1720049224 — BERNARD D STEIN M.D.
Practice Location Address:
508 S HABANA AVE , SUITE 160
TAMPA, FL
33609-4181
Practice Phone: 813-877-6511
Practice Fax: 813-872-5695

Directions to “BAYSHORE PODIATRY CENTER INC ” Practice Location

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